Tetraplegia in the immediate postoperative period of stapedectomy

Management of the cervical spine in orotracheal intubation for general anesthesia is an important aspect of daily practice in anesthesiology. Also important are the requirements, techniques and consequences of patient position during surgery. We report a case of tetraplegia during the early postoperative period after stapedectomy for otosclerosis. After surgery, the spontaneously breathing patient was transferred to the recovery room, where a clinical picture of anesthesia and paralysis of all four limbs was evident. We ordered an emergency magnetic resonance image of the cervical spine, which revealed a massive acutely herniated disk at C6-C7 with signs of ischemia or necrosis of the medulla at the same level. After eight months, the patient was still paraplegic and lacked sensation in the lower limbs. Sensation and motor function in the upper limbs was nearly normal. We review the etiopathogenetic mechanisms that might be responsible for this clinical profile.     

Locoregional anesthesia for external ear surgery and postoperative analgesia

OBJECTIVES: To evaluate a change in the classical technique for local-regional anesthesia (periauricular "V" infiltration) for surgery on the outer ear, specifically adding a new infiltration of the osteocartilaginous juncture of the external acoustic meatus and the auditory foramen, as an alternative to general anesthesia in adults, including assessment of postoperative analgesia. PATIENTS AND METHODS: The new technique was used in 45 operations on 23 patients. We analyzed pain during and after surgery on a simple verbal scale. RESULTS: After modifying the technique it was possible to perform surgery on the outer ear without causing pain, patients reporting "0" pain on a scale of 0 to 10. Eight patients reported "0" for postoperative pain, while one assessed pain as "4" and one as "2". No signs of emesis or cardiac events were observed. CONCLUSIONS: The described local-regional blockade of the outer ear used as the only anesthetic method, is indicated for both cosmetic surgery and repair of outer ear injuries, given its excellent analgesia during and after surgery. The characteristics of this type of block of the pavilion make it ideal for major outpatient surgery and a valid alternative to general anesthesia in adults.     

Reduction of blood transfusion need with aprotinin in orthopedic surgery. Spanish Study Group on the Use of Aprotinin in Hip Arthroplasty (GEEEAAC)

Aprotinin is a protease inhibitor of interest for its antifibrinolytic effect of reducing perioperative bleeding in certain types of surgery, with wide use in heart surgery, liver transplantation and vascular surgery. The application of aprotinin during orthopedic surgery has recently been suggested. Such use is controversial, as there is lack of consensus as to the type of patient for whom aprotinin administration would be indicated, the surgical procedure during which it would be most effective (hip or knee arthroplasty, spinal arthrodesis, major tumor or septic surgery), the doses to administer, its safety and its real efficacy for conserving homologous blood. That is to say, there is no agreement as to the cost/benefit relation of aprotinin for the various types of orthopedic surgery. This critical review of the literature leads to the conclusion that aprotinin is a promising drug for use in orthopedic surgery, given that published studies have established the benefit in blood product savings and decreased blood loss during surgery.     

Descending necrotizing mediastinitis

Between 1990-1999, six patients (mean age, 41.5 years) with the diagnosis of descending necrotizing mediastinitis were surgically treated at our institution. All patients underwent cervical drainage plus an aggressive mediastinal debridement and drainage via posterolateral thoracotomy. The outcome was favorable in all cases. All patients received initially a high dose of broad-spectrum antibiotics. In four patients, a tracheostomy was necessary for respiratory management. We also review the literature.